Mongolia extends an innovative outreach health approach for children and families in isolated regions

A first-grade student walks several kilometres to her home after school in the district of Altai, in Khovd Province. A mountain range rises in front of her.

7 June 2011, Ulaanbaatar, Mongolia – The health and nutrition of children and women living in remote or isolated areas of the vast, sparsely populated country of Mongolia will further improve with the recent commitment of the Government of Mongolia to ensure that they receive quality outreach health services.

The approach titled ‘Reach Every District and Soum’ (village), (REDS) began as a pilot by UNICEF for ensuring all children received essential vaccines regardless of how isolated they were from health services. REDS was then expanded to integrate other health concerns impacting women and children and has now been adopted for national implementation by the Government.

The approach starts by mapping where women and children live and identifying obstacles or bottlenecks to their ability to access services. Based on this information, a plan is developed for trained health workers to traverse long and difficult distances, often in harsh and dangerous weather, to promote preventative and cost effective health services.

Vice Minister of Health Dr. Tsolmon Jadamba is helping to administer a vaccine dose to a young girl, who is one of over 100 children staying at the Address Identification and Protection Center.

Services range from vaccination and primary health care, maternal and child health and nutrition, to capacity building of parents and strengthening of community partnerships. In collaboration with UNFPA, the approach will add reproductive health services and commodities to the package of health services provided.

The most disadvantaged children and women are the primary target of the REDS approach, including disabled, remote and temporary populations, children living in orphanages, single mothers, children engaged in labour and school drop-outs.

In addition to reaching the poorest and most isolated in communities, the approach is proving essential in extending health services to those populations who have recently migrated from rural to peri-urban areas, who remain unregistered and therefore unreached by health services and uncounted in the administrative health data”, said Rana Flowers, UNICEF Representative.

The scaling up of the REDS approach is a further commitment by the Ministry of Health in Mongolia to achieve MDGs 4 and 5 on maternal and child health. Many of the high impact health interventions to protect and save the lives of mothers and children have been successfully scaled up achieving a high level of coverage thanks to the Government’s health policy. However, unreached pockets of the population remain distant from high impact health and nutrition interventions.

The strategy has been piloted in specific areas since 2008 and an assessment of the approach has confirmed its success in reducing the incidence of severe disease, vastly enhancing service provision and the demand for services by excluded populations, identifying and ensuring services to unregistered populations (more than 5% of the population in certain communities), and raising public and stakeholder awareness about the needs of the vulnerable.

“The assessment confirmed that the current financing and service-delivery models of the Ministry of Health, while a strong foundation for health service access for the majority of the population, are not yet working effectively for the very poor or hard to reach”, said Flowers. “In addition to the health concerns, these populations also need a range of welfare and additional social services – thus, support with civil and health facility registration, shelter, emergency nutritional support and employment assistance are now incorporated where possible in this outreach strategy” she added.

Key recommendations from the pilots are being taken into consideration for the nation-wide scaling up of the strategy. Under discussion is the need to ensure policy flexibility to respond to escalating social distress and health inequalities, pro-poor health financing mechanisms, reorientation of Family Group Practices from a primary medical approach to a primary health care approach as well as a better integration of community development, water and sanitation, education and employment challenges to further complement this approach.